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Sudden onset shortness of breath

Clinical Discipline(s)/Organ System(s)
Respiratory Medicine, Respiratory System, Immunology
Progress Test Topic(s)
Respiratory
Description
A 17 year old Tokelauan woman, with a background of asthma, is brought into the Emergency Department after becoming suddenly short of breath with associated wheezy breathing. She is distressed but speaking in long sentences.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3 | Question 4 | Question 5
Applied Science for Medicine 
   - Anatomy and function of the respiratory tract including larynx/upper airway; microanatomy of airways
   - Pulmonary mechanics, gas exchange, control of breathing
   - Anatomy and physiology of pulmonary vasculature
   - Coagulation; risk factors for and mechanisms of thromboembolism
   - Pathophysiology of asthma; mechanism and pathophysiology of exercise-induced asthma
   - Physiology of acute airway obstruction; intra- vs extra-thoracic, focal vs diffuse airflow obstruction
   - Mechanism and diagnosis of stridor
   - Pathophysiology of pneumothorax, pulmonary embolism
   - Type I hypersensitivity, immunoglobulin E (IgE) , mast cells, eosinophils
   - Pharmacology of beta-2 adrenoceptor agonists, inhaled anti-inflammatory corticosteroids, ipratropium, leukotriene receptor antagonists, sodium cromoglycate
Clinical and Communication Skills 
   - History from a patient with acute shortness of breath; relevant history for a patient with asthma including circumstances of acute attack and background control;relevant history for a patient with anaphylaxis/laryngeal odema; relevant history for a patient with pneumothorax; relevant history for a patient with pulmonary embolism
   - Perform a rapid and targeted examination of a patient with sudden onset shortness of breath; recognise respiratory distress and a pneumothorax
   - Differential diagnosis of sudden onset shortness of breath
   - Diagnosis of hyperventilation syndrome
   - Co-morbidities of patients with airways disease
   - Perform Peak Expiratory Flow (PEF), spirometry and arterial blood gas
   - Perform and interpret relevant investigations: PEF, arterial blood gas, bloods and chest X-ray
   - Indications for detailed pulmonary function tests, CT pulmonary angiogram, V/Q scan
   - Classify acute asthma into mild, moderate, severe and life-threatening
   - Management of acute asthma including respiratory arrest
   - Management of chronic asthma; pharmacological, non-pharmacological; patient education
   - Classify pulmonary embolism: massive, sub-massive
   - Management of pulmonary embolus (acute and longer term) and pneumothorax
   - Management of anaphylaxis/laryngeal odema
   - Prognosis of asthma, pulmonary embolus and pneumothorax
Personal and Professional Skills 
   - Understanding barriers to accessing healthcare for adolescents
   - Interprofessional management of chronic disease
   - Discussion of treatment options
Hauora Māori 
   - Appropriate engagement and consultation with whānau
   - Importance of whānau for adolescent wellbeing
   - Ability to cater for differential health literacy needs of Māori patients and whānau
Population Health 
   - Socio-economic determinants of health
   - Preventative health and health promotion needs for adolescents
   - Epidemiology of asthma and atopy/anaphylaxis
   - Pharmaco-epidemiology relevant to asthma
Conditions to be considered relating to this scenario
Common
asthma, anaphylaxis/laryngeal oedema, pulmonary embolism, simple/tension pneumothorax, anxiety/hyperventilation
Less common but 'important not to miss'
heart failure ('flash' pulmonary odema, consider rheumatic heart disease as an underlying cause), substance abuse, cardiac tamponade
Related Scenarios
[Pneumonia], [Deep vein thrombosis]